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Query: UMLS:C0149871 (deep vein thrombosis)
 12,364 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Venous function measured by air-plethysmography (APG) was compared to anatomical patterns of reflux assessed by duplex scanning and associated clinical features in 253 limbs with recurrent varicose veins following previous superficial venous surgery. The results showed that a previous history of deep venous thrombosis, previous procedure with preservation of the long saphenous vein, and a history of healed ulcer or current ulcer were each associated with worse venous function. Patterns of reflux which included multiple sites of reflux and presence of deep incompetence were also associated with worse venous function. Where there was reflux in the groin, limbs with a wide recurrent saphenofemoral junction presented the worst venous filling time and venous filling index, whereas those with reflux unrelated to the common femoral vein had nearly normal venous physiology and occurred almost exclusively in females. The other patterns of recurrence in the groin were physiologically indistinguishable from each other. In conclusion, certain patterns of reflux, clinical and operative features are associated with worse venous physiology in limbs with recurrent varicose veins. These features of recurrence with more severe physiological disturbance may necessitate a higher priority for surgical intervention.
Cardiovasc Surg 2000 Mar
PMID:Venous physiology in the different patterns of recurrent varicose veins and the relationship to clinical severity. 1073 49

The placement of Swan Ganz (SW) catheters and inferior vena cava (IVC) filters are common procedures performed in critically ill patients. Many reports describe the independent misplacement of SG catheters and IVC filters, and others have reported migration of IVC filters and entanglement of various intravascular devices in IVC filter. Our patient is a 70-year-old Caucasian woman who underwent an aortic valve replacement and coronary artery bypass grafting. The patient developed a deep venous thrombosis and an infrarenal IVC filter was placed without incident. A Swan Ganz catheter was placed later in the postoperative period and became entangled in the IVC filter. We advised operative removal after several unsuccessful percutaneous attempts to retrieve the catheter. IVC filters are indicated for prevention of fatal pulmonary emboli in patients with a contraindication to anticoagulants or with recurrent embolism despite adequate anticoagulant therapy. Complications of IVC filters include caval thrombosis, retroperitoneal hemorrhage and perforation of the IVC, hepatic veins, duodenum and aorta. We describe our evaluation and operative approach and make recommendations for prevention of entangling the SG into the IVC filter.
J Cardiovasc Surg (Torino) 1999 Dec
PMID:Entrapment of a Swan Ganz catheter in an IVC filter requiring caval exploration. A case report. 1077 29

Deep vein thrombosis, pulmonary embolism, and pulmonary thrombosis in situ are rare in childhood and adolescence [1,2]. Unfortunately, these diagnoses may be unsuspected in a pediatric patient with dyspnea and chest pain. This article illustrates the diagnostic and therapeutic challenges that arose from unrecognized chronic thrombotic disease in an adolescent.
Catheter Cardiovasc Interv 2000 May
PMID:Pulmonary thrombosis, homocysteinemia, and reperfusion edema in an adolescent. 1081 82

In spite of improvements in the diagnosis and treatment of thromboembolic disease, pulmonary embolism continues to be a major cause of morbidity and mortality. Anticoagulation remains the preferred therapy for deep venous thrombosis; however, this form of treatment is either ineffective or contraindicated for some patients. For these patients, partial interruption of the inferior vena cava via percutaneous filter placement has become the procedure of choice to protect against fatal pulmonary embolism. We described in this paper results obtained with the available permanent filters and complications of these filters described in the literature. We highlighted the interest of temporary filters in patients whose thromboembolic risk is temporary, finally we insist on recognised indications for vena cava filters when anticoagulation is contraindicated or ineffective.
Cardiovasc Surg 2000 Oct
PMID:Emergency interruption of the inferior vena cava: a debatable issue. 1099 93

Initially, patients with deep vein thrombosis (DVT) should be treated with a 5- to 7-day course of heparin or low-molecular-weight heparin (LMWH). They can be administered LMWH as outpatients. Patients with extensive iliofemoral thrombosis, major pulmonary embolism, or concomitant medical illness, and those at high risk for bleeding, should be treated as inpatients. Thrombolytic therapy may be considered for patients with extensive iliofemoral thrombosis if there is no contraindication to the use of thrombolytic drugs. Oral anticoagulants can be started within 24 hours of the initiation of heparin or LMWH. Warfarin is started at a dose of 5 mg, and subsequent doses are given in amounts sufficient to achieve an international normalized ratio of 2.0 to 3.0. Inferior vena caval filters should be considered for patients with overt bleeding or for those at high risk for hemorrhage. Warfarin can be used for secondary prophylaxis in most patients. Patients in whom there are contraindications to the use of oral anticoagulants and patients in whom recurrent venous thromboembolism (VTE) develops while they are receiving therapeutic doses of warfarin can be safely and effectively treated with LMWH. Patients with idiopathic DVT should be treated with anticoagulants for at least 6 months. Those with calf DVT or proximal DVT that complicates surgery or medical illness can be treated with anticoagulants for 6 weeks and 3 months, respectively, provided that there are no ongoing risk factors for recurrent VTE. Oral anticoagulants are teratogenic and should be avoided by patients who are pregnant; unfractionated heparin or LMWH are safe alternatives. Unfractionated heparin, LMWH, and oral anticoagulants can be safely administered to nursing mothers.
Curr Treat Options Cardiovasc Med 1999 Jun
PMID:Deep Vein Thrombosis. 1109 68

The goals of treating patients with upper-extremity deep vein thrombosis (UEDVT) are to relieve acute symptoms of venous occlusion, prevent pulmonary embolism, reduce the likelihood of recurrent thrombosis, and avoid the development of postphlebitic syndrome. Although the details of management differ, depending on the underlying cause and precipitating factors, anticoagulant therapy should be the first-line treatment of choice in all cases. For patients with primary or idiopathic UEDVT (Paget-von Schroetter syndrome), aggressive measures including catheter-directed thrombolysis, vascular procedures (eg, balloon angioplasty, stenting, filter), and surgical maneuvers (eg, first rib resection) have been advocated by some surgeons, but none of these high-risk interventions has been evaluated properly in prospective controlled trials. In contrast, for patients with catheter-associated central venous thrombosis (CACVT), or other secondary cases of UEDVT, many clinicians simply withdraw the catheter and avoid anticoagulant therapy. Because well-designed clinical trials are lacking, recommendations about the management of UEDVT are derived from descriptive studies and case series. Until further research identifies the natural history and optimum management of UEDVT, it seems reasonable to base treatment on anticoagulant regimens with proven effectiveness in lower-extremity deep vein thrombosis (LEDVT). The use of additional intervention(s) should be reserved for carefully selected patients.
Curr Treat Options Cardiovasc Med 2001 Jun
PMID:Venous Thrombosis of the Upper Extremities. 1134 66

Older individuals contribute heavily to the percentage of deaths due to myocardial infarction (MI) and stroke. The incidence of venous thromboembolism (VTE) is highest in subjects > 65 years. Prospective intervention trials involving groups of clinically comparable subjects > or = 60 allow the following statements to be made with regard to the use of antithrombotic drugs in the elderly. Antiplatelet agents. To prevent recurrence of ischaemic stroke and MI in stable/unstable angina, MI, TIA/stroke or peripheral arterial disease, aspirin is the drug of choice. Clopidogrel is more effective than aspirin in this respect. Heparin. For the treatment of acute deep venous thrombosis (DVT) and pulmonary embolism (PE), intravenous standard heparin or subcutaneous standard heparin are effective (aPTT 1.5-2.0 times baseline values). As the risk of bleeding increases with age, low-molecular-weight heparins (LMWH) are preferable in the elderly. For the prophylaxis of VTE in general surgery in subjects at low-moderate risk, low-dose heparin or low doses of LMWH are effective. In subjects at high risk, adjusted-dose heparin plus physical devices or high-dose LMWH are recommended. The combination of heparin and aspirin is the standard treatment for unstable angina and non-Q wave MI. LMWH are as active as standard heparin in this indication. Vitamin K antagonists. For the chronic treatment of VTE, warfarin is also the treatment of choice (INR 2.0-3.0) in the elderly, though lower doses are needed due to their hypersensitivity to oral anticoagulants. For the prevention of thromboembolic stroke in patients > 75 with atrial fibrillation, warfarin is the drug of choice. Patients aged 65-75 may receive warfarin or aspirin. Thrombolytic agents. Thrombolytic agents are not recommended for treating DVT in the elderly because of their limited risk/benefit ratio and should be confined to massive PE. In the absence of contraindications, thrombolysis for MI may be considered in the elderly.
Nutr Metab Cardiovasc Dis 2001 Feb
PMID:Antithrombotic drugs for older subjects. Guidelines formulated jointly by the Italian Societies of Haemostasis and Thrombosis (SISET) and of Gerontology and Geriatrics (SIGG). 1138 24

Venous thrombosis involving the deep veins is a major US health problem that affects over 2.5 million people annually. The most serious complication of a deep venous thrombosis (DVT) is pulmonary embolism (PE), which is associated with 50,000 to 200,000 deaths each year. DVT and PE are often silent and difficult to detect by clinical examination; however, DVT rarely occurs in the absence of risk factors. This article reviews normal venous anatomy and discusses the etiology of DVT, its clinical manifestations, and diagnosis. Then it reviews treatment of DVT, highlighting the nurse's role. A discussion of DVT prophylaxis based on patient risk follows.
J Cardiovasc Nurs 2001 Jul
PMID:Deep venous thrombosis. 1141 64

Acute symptomatic upper extremity deep vein thrombosis (DVT) are estimated to account for only 2-4% of all deep vein thrombosis. Upper extremity DVT leading to phlegmasia cerulea dolens (PCD) occurs in an estimated 2-5% of these cases. Progression of PCD to venous gangrene is extremely rare with only 16 previously reported cases in the literature. Only 7 of the cited cases document significant tissue loss. This report describes a 61-year-old male who developed upper extremity DVT complicated by PCD which led to venous gangrene and limb loss.
J Cardiovasc Surg (Torino) 2001 Aug
PMID:Upper extremity venous gangrene following coronary artery bypass. A case report and review of the literature. 1145 95

In order to elucidate the natural history of upper extremity deep venous thrombosis (UEDVT), we compared the morbidity and mortality of patients with UEDVT and that of patients with both UEDVT and lower extremity deep venous thrombosis (LEDVT). Between 1993 and 1996, 21 patients presented to our institution with both LEDVT and UEDVT (Group 1). During the same time period, 144 patients were diagnosed with UEDVT alone (Group 2). The diagnosis was confirmed by duplex scanning in all patients. In Group 1, there were 14 females (67%) and 7 males (23%) with ages ranging from 25 to 97 yr old [mean 73 yr old +/-17 yr (SD)]. In Group 2, there were 84 females (58%) and 60 males (42%) with ages ranging from 9 to 101 yr old [mean 67 yr old +/-17 yr (SD)]. Differences in age and sex between the two groups were not statistically significant. In Group 1, systemic anticoagulation was implemented in 17 patients (81%). Two patients (9.5%) required placement of a SVC and IVC filters due to contraindication to anticoagulation. One patient did not receive anticoagulation, and one patient was only started on aspirin. In Group 2, treatment consisted of systemic anticoagulation in 94 patients (65%). The remainder of the patients were treated with aspirin in three patients (2%) or no anticoagulation in 31 patients (19%). Sixteen patients (11%) underwent placement of a SVC filter either due to failure of anticoagulation to prevent pulmonary embolism (two patients) or contraindication to anticoagulation (14 patients). Pulmonary emboli were documented by ventilation/perfusion lung scan in two patients (9.5%) in Group 1 and in 16 patients (11%) in Group 2. In the first group, 8 of the 21 patients (38%) were dead within 1 month of the diagnosis of UEDVT, and 11 of 21 patients (52%) were dead within 2 months of the diagnosis of UEDVT. In the second group, 20 of 144 patients (14%) were dead within 1 month of the diagnosis of UEDVT and 38 of 144 patients (26%) were dead within 2 months of diagnosis (P<0.02). Our data suggest that patients with both UEDVT and LEDVT have a higher mortality than patients with UEDVT alone. As the risk for pulmonary embolism is similar in both groups, we speculate that the severity of medical illness in patients with both UEDVT and LEDVT may contribute to the higher mortality. This is the first study to examine the mortality of this group of patients.
Cardiovasc Surg 2001 Oct
PMID:Combined upper and lower extremity deep venous thrombosis. 1148 52


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